Arthritis Care & Research最新文献

{"title":"High Health Care Utilization Preceding Diagnosis With Juvenile Idiopathic Arthritis.","authors":"Anna Costello, Rui Xiao, Xuemei Zhang, Jahan Jazayeri, Irit R Rasooly, Pamela F Weiss","doi":"10.1002/acr.80037","DOIUrl":"10.1002/acr.80037","url":null,"abstract":"<p><strong>Objective: </strong>Although early diagnosis improves long-term outcomes, patients with juvenile idiopathic arthritis (JIA) often experience prolonged, circuitous paths to diagnosis. To inform diagnostic improvement, we sought to characterize health care utilization in the year preceding diagnosis.</p><p><strong>Methods: </strong>We identified 10,021 patients with an incident diagnosis of JIA and 20,042 age- and sex-matched healthy controls in the Merative MarketScan administrative datasets (2014-2022). Using negative binomial or hurdle models, we calculated incidence rate ratios (IRRs) comparing outpatient, inpatient, and emergency department or urgent care (ED/UC) utilization between patients with JIA and controls.</p><p><strong>Results: </strong>In the year before diagnosis, patients with JIA had significantly increased health care utilization compared to controls (IRR 2.55 [95% confidence interval (CI) 2.49-2.62], P < 0.001). Accounting for sex, age, and insurance, utilization was increased across care settings: outpatient (IRR 2.56 [95% CI 2.49-2.62], P < 0.001), inpatient (IRR 2.00 [95% CI 1.48-2.71], P < 0.001), and ED/UC encounters (IRR 1.76 [95% CI 1.67-1.86], P < 0.001). The most common visits by patients with JIA preceding diagnosis were to a general practitioner (91.8%), ED/UC (47.0%), and orthopedist (22.9%). Health care utilization increased as the index date approached. In patients insured by Medicaid, ED/UC care was more frequent (odds ratio 2.05 [95% CI 1.89-2.23]) and orthopedic care less frequent (odds ratio 0.27 [95% CI 0.24-0.34]) than in patients with commercial insurance.</p><p><strong>Conclusion: </strong>In the year before diagnosis, children with JIA have significantly higher health care utilization compared to healthy peers. There are differences in the patterns of utilization in patients with Medicaid versus commercial insurance. There may be opportunities for earlier identification of JIA in primary care, orthopedics, and ED/UC.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":"1544-1551"},"PeriodicalIF":4.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147375938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paper retraction and reviewer constraints: comment on the article by Vettori and Iudici.","authors":"Shigeki Matsubara","doi":"10.1002/acr.80043","DOIUrl":"10.1002/acr.80043","url":null,"abstract":"","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":"1576-1577"},"PeriodicalIF":4.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Retinopathy Associated with Long-Term Use of Hydroxychloroquine in Patients with Rheumatic Diseases: A Systematic Review and Meta-Analysis.","authors":"Narsis Daftarian, Chloe Yue, Steve D Levasseur, Hui Xie, J Antonio Avina-Zubieta","doi":"10.1002/acr.80033","DOIUrl":"10.1002/acr.80033","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to estimate the prevalence and cumulative incidence of hydroxychloroquine retinopathy (HCQ-R) and its risk factors among patients receiving long-term HCQ with rheumatic diseases through a systematic review and meta-analysis of observational studies that used spectral-domain optical coherence tomography (SD-OCT) for screening.</p><p><strong>Methods: </strong>A systematic search of PubMed, Scopus, Ovid EMBASE, and World Health Organization databases (inception-December 31, 2025) identified observational studies meeting the following criteria: 1) adults with rheumatic diseases on HCQ for at least one year, 2) SD-OCT used for HCQ-R screening, 3) reported HCQ-R prevalence or cumulative incidence or calculable data, 4) reported HCQ-R risk factors as hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs), and 5) English full text. Study quality was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis estimated pooled prevalence, cumulative incidence, and risk-factor associations.</p><p><strong>Results: </strong>We screened 827 studies from which an overall 19 met inclusion criteria (18 cohort and 1 case-control). Pooled HCQ-R prevalence from 2008 to 2023 was 5.1% (95% CI 3.9-6.5). Pooled cumulative incidence was 0.1% (95% CI 0.0-0.5) at 5 years, 2.6% (95% CI 1.6-4.1) at 10 years, and 5.6% (95% CI 3.2-9.6) at 15 years. Risk factors measured as HR (95% CI) included daily dose >5 mg/kg actual body weight (4.32 [2.80-6.65]), chronic kidney disease (CKD) (1.94 [1.27-2.96]), female sex (3.78 [1.90-7.48]), and Asian vs White ethnicity (1.67 [1.07-2.62]).</p><p><strong>Conclusion: </strong>HCQ-R risk increases with duration and is dose-dependent, reaching 5.6% by 15 years. Findings support dose optimization with intensified screening for higher-risk patients, including those with CKD or those who are female and/or Asian.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":"1532-1543"},"PeriodicalIF":4.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Formal and Informal Social Care in People With Rheumatic and Musculoskeletal Diseases: A Cross-Sectional Multicenter Survey.","authors":"Mehreen Somro, Karen Durrant, William G Dixon, John McBeth, Alex MacGregor, Max Yates, Jenny H Humphreys","doi":"10.1002/acr.80031","DOIUrl":"10.1002/acr.80031","url":null,"abstract":"<p><strong>Objective: </strong>Rheumatic and musculoskeletal diseases (RMDs) are leading causes of physical disability, necessitating support with activities of daily living. This study describes social care received by patients with RMDs in two disparate regions of England: Salford (urban) and Norfolk (rural).</p><p><strong>Methods: </strong>A cross-sectional survey identified how many patients received care and who provided it as well as care type (formal/informal), frequency, and duration. Participants included (1) patients attending rheumatology outpatient facilities at Salford Royal Hospital and (2) participants with inflammatory polyarthritis enrolled in the Norfolk Arthritis Register (NOAR). Descriptive statistics compared the care received, and a logistic regression model investigated factors associated with receiving help.</p><p><strong>Results: </strong>The Salford cohort was younger and had a wider range of RMDs compared with NOAR. A significant number of participants in the Salford (85%) and NOAR (38%) groups required help with daily activities. Of those needing help, 61% and 73% received care in Salford and NOAR, respectively, predominantly informally from family and friends. Local authorities delivered social care to just 0.5% of Salford and 1.4% of NOAR participants. Daily care was provided to 43% of Salford and 53% of NOAR participants. Weekly care duration varied: 21% of Salford and 31% of NOAR responders received ≤4 hours, and 19% of Salford and 10% of NOAR responders received >20 hours. Having multiple conditions increased the likelihood of receiving care: Salford odds ratio 1.93 (95% confidence interval [CI] 1.18-3.18) and NOAR odds ratio 3.30 (95% CI 1.45-7.60).</p><p><strong>Conclusion: </strong>The survey highlights a lack of formal care for patients with RMDs, who mostly rely on undocumented informal care. Patients with multiple conditions often require daily living assistance; rheumatology services should consider incorporating social care reviews as part of routine practice.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":"1522-1531"},"PeriodicalIF":4.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trajectories of Physical Function in Canadian Children With Juvenile Idiopathic Arthritis.","authors":"Clare Cunningham, Meghan McPherson, Lillian Lim, Roberta A Berard, Matthew Berkowitz, Jean-Philippe Proulx-Gauthier, Brian M Feldman, Nicole Johnson, Dax G Rumsey, Heinrike Schmeling, Lori B Tucker, Thomas Loughin, Kristin M Houghton, Jaime Guzman","doi":"10.1002/acr.80039","DOIUrl":"10.1002/acr.80039","url":null,"abstract":"<p><strong>Objective: </strong>We describe trajectories of physical function in children newly diagnosed with juvenile idiopathic arthritis (JIA) and identify trajectories with persisting functional impairments and associated baseline characteristics.</p><p><strong>Methods: </strong>We included patients enrolled in the Canadian Alliance of Pediatric Rheumatology Investigators (CAPRI) Registry between 2017 and 2024 whose parents provided Kids Disability Screen (KDS) scores from at least two visits (from 0 = no disability to 10 = severe disability). Analyses included descriptive statistics, locally weighted scatterplot smoothing, Kaplan-Meier plots of time to KDS = 0, latent class trajectory analysis (LCTA), and classification trees to predict trajectories with persisting impairments.</p><p><strong>Results: </strong>We included 940 patients providing 7,351 KDS scores starting at a median 6 days after diagnosis up to 7 years. Baseline KDS scores were highest for rheumatoid factor-positive polyarthritis (mean 4.9, SD 3.1) and lowest for psoriatic arthritis (mean 2.4, SD 2.5), and mean scores improved within the first year in all JIA categories. Median time to KDS = 0 was 36 weeks (from 13 weeks for systemic arthritis to 73 weeks for undifferentiated arthritis). LCTA identified five trajectories: one with little measurable impairment (38% of patients), two with impairments resolving in one to two years (24%), and two with persisting mild impairments (38%). A baseline KDS ≥1.5 had a sensitivity of 0.79 and specificity of 0.48 to detect persisting mild impairment trajectories. There were no trajectories with persisting moderate or severe impairments.</p><p><strong>Conclusion: </strong>Most children with JIA in this cohort had mild to moderate functional impairments at diagnosis that resolved in one to two years, but one in three followed trajectories with mild persisting impairments.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":"1564-1573"},"PeriodicalIF":4.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147375877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply.","authors":"Anna Maria Vettori, Michele Iudici","doi":"10.1002/acr.80047","DOIUrl":"10.1002/acr.80047","url":null,"abstract":"","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":"1577-1578"},"PeriodicalIF":4.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147502959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply.","authors":"Anne C Bull Haaversen, Lene K Brekke, Tanaz A Kermani, Øyvind Molberg, Andreas P Diamantopoulos","doi":"10.1002/acr.80061","DOIUrl":"10.1002/acr.80061","url":null,"abstract":"","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":"1575-1576"},"PeriodicalIF":4.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building a Framework for Sexual and Reproductive Health Care in the Rheumatology Context: Content and Approaches.","authors":"Mehret Birru Talabi, Sonya Borrero","doi":"10.1002/acr.80049","DOIUrl":"10.1002/acr.80049","url":null,"abstract":"<p><p>People with systemic autoimmune and rheumatic diseases (SARDs) are at higher risk than the general population of experiencing adverse pregnancy and perinatal outcomes such as preeclampsia, intrauterine growth restriction, and maternal and/or fetal death. The immune system undergoes changes during pregnancy that can precipitate adverse health outcomes among people with immunologic dysfunction at baseline-particularly those people who have active inflammatory disease at the time of and/or during pregnancy. However, in this commentary, we challenge the notion that immunologic and disease-centric aspects of pregnancy are the only drivers of adverse pregnancy and perinatal outcomes among people with SARDs. A focus on disease may have limited focus on other factors that could enhance reproductive health outcomes among people with SARDs, for example, the provision of high-quality sexual and reproductive health (SRH) care in the rheumatology context. Identification of such upstream factors can reveal approaches that enhance downstream reproductive outcomes for all women with rheumatic diseases, thereby enhancing person centeredness, holistic care, and SRH equity in rheumatology care. Herein, we also describe emerging approaches to SRH that provide a potential framework for high-quality SRH care in the rheumatology context.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":"1510-1521"},"PeriodicalIF":4.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147608085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rheumatoid Arthritis, Frailty, and Outcomes of Surgical Hospitalizations: A National Population-Based Analysis.","authors":"Ali Yazdanyar, Joshua Baker, Katherine D Wysham, Mohammed Yousufuddin, Farah Acher Kaiksow, Michael M Ward","doi":"10.1002/acr.80171","DOIUrl":"10.1002/acr.80171","url":null,"abstract":"<p><strong>Objective: </strong>Hospitalization, particularly for surgery, represents a period of heightened stress. We evaluated how frailty attenuates the association of rheumatoid arthritis (RA) with negative health outcomes after elective noncardiac surgery.</p><p><strong>Methods: </strong>We conducted a cross-sectional study using the National Inpatient Sample (2018 to 2020), including adults (aged ≥18 years) with elective hospitalizations with noncardiac surgery. Frailty was measured using the Hospital Frailty Risk Score (HFRS). Surgeries were categorized by risk level. Outcomes included discharge health resources need (DHRN), composite adverse clinical events (CACE), and death.</p><p><strong>Results: </strong>Among 8,800,359 hospitalizations (2.14% among patients with RA), 73.36% underwent intermediate-risk surgery and 62.25% had HFRS above 0. DHRN occurred in 28.9%, CACE occurred in 0.93%, and all-cause mortality occurred in 0.17%. A 10-point increase in HFRS was associated with a 3.8-fold increased DHRN, 8.5-fold increased CACE, and 22.8-fold increased mortality. RA was not independently associated with CACE (adjusted odds ratio [aOR] 0.91; 95% confidence interval [CI] 0.82-1.01; P = 0.08) or death (aOR 0.90; 95% CI 0.71-1.15; P = 0.41) but was significantly associated with DHRN (aOR 1.28, 95% CI 1.25-1.31; P < 0.001) after adjusting for confounders and frailty. In sensitivity analysis, RA had 10% higher relative odds of DHRN following orthopedic (aOR 1.10; 95% CI 1.07-1.13; P < 0.001) but not nonorthopedic intermediate-risk surgery (aOR 1.10; 95% CI 0.98-1.23; P = 0.11).</p><p><strong>Conclusion: </strong>RA was associated with higher odds of DHRN after orthopedic intermediate-risk surgery but not CACE or inpatient mortality. Moreover, HFRS was associated with DHRN, CACE, and death. These findings underscore the need for disease-specific clinical considerations and highlight the potential utility of HFRS in discharge planning.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Effectiveness of Tocilizumab and Tumor Necrosis Factor Inhibitors in Takayasu Arteritis: Age-Related Differences in Treatment Response.","authors":"Sreenidhi Sankararaman, Alessandro Tomelleri, Corrado Campochiaro, Luciana Yamamoto de Almeida, Chiara Bellino, Elena Baldissera, Lorenzo Dagna, Leonardo Salhani, Julia Shek, Peter C Grayson, Kaitlin A Quinn","doi":"10.1002/acr.80169","DOIUrl":"10.1002/acr.80169","url":null,"abstract":"<p><strong>Objective: </strong>Comparative, prospective data on biologics for Takayasu arteritis (TAK) are limited. We compared tumor necrosis factor inhibitors (TNFi) and tocilizumab (TCZ) in a combined cohort, assessed demographic and cytokine influences, and evaluated longitudinal outcomes.</p><p><strong>Methods: </strong>Clinical response to TNFi or TCZ was assessed in patients with TAK from two independent cohorts. In a subset followed prospectively within a standardized research protocol, physician global assessment (PGA), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) activity were compared pretreatment and posttreatment. Time to response was analyzed using Kaplan-Meier curves. Cytokine levels were measured with Luminex assays in patients and age-matched healthy controls.</p><p><strong>Results: </strong>Among 151 patients (cohort A = 57; cohort B = 94), 129 received TNFi and 56 received TCZ during follow-up. Clinical response rates were 72.1% for TNFi and 60.7% for TCZ (P = 0.17). In the prospective subset, no significant differences in PGA, CRP, ESR, or FDG-PET outcomes (P > 0.30) were observed. Changing to another TNFi or switching between TNFi or TCZ after treatment failure resulted in clinical response in 31 of 33 (94%) patients. TNFi responders had a younger median age at onset than nonresponders (23 vs 33.5 years, P = 0.0039), whereas TCZ responders were older (35 vs 21.5 years, P = 0.0043). Patients with onset <30 years showed elevated interleukin-6 and TNF versus controls, a pattern not observed in older patients.</p><p><strong>Conclusion: </strong>TNFi and TCZ demonstrated similar effectiveness in TAK. These findings support therapeutic switching after treatment failure and suggest that age-related immunologic differences may influence treatment response.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149068793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}